Association between frailty and 30-day outcomes after discharge from hospital

Readmissions after hospital discharge are common and costly, but prediction models are poor at identifying patients at high risk of readmission. This study evaluated whether frailty identified using the Clinical Frailty Scale was an independent predictor of death or readmission within 30 days after discharge from hospital. Prospectively patients discharged from 7 medical wards at 2 teaching hospitals in Edmonton were examined.

Of the 495 patients included in the study, 162 (33%) met the definition of frailty: 91 (18%) had mild, 60 (12%) had moderate and 11 (2%) had severe frailty. Frail patients were older and had more comorbidities, lower quality of life and higher LACE scores at discharge than those who were not frail. The composite of 30-day readmission or death was higher among frail than among non-frail patients (39 [24.1%] vs. 46 [13.8%]).

Three key findings from this study are noteworthy. First, frailty was common among patients being discharged from the medical wards, even among patients being discharged home. Second, frailty was associated with an increased risk of readmission or death within 30 days after discharge and increased use of health services even after adjustment for age and sex. Finally, the presence of moderate to severe frailty added prognostic information that improved the ability to predict rates of readmission or death beyond the LACE score, currently the best risk-prediction model.

In summary, frailty is common and associated with poorer outcomes after discharge.